Implementing a hospital-wide protocol for Staphylococcusaureus bacteremia

AbstractStaphylococcus aureus bacteraemia (SAB) is associated with high-mortality and complication rates. A multidisciplinary approachis needed to predict, detect and treat complications. In this pre- and post-intervention study, we investigated the effects of ahospital-wide protocol for diagnosis, classification and treatment of SAB. It was hypothesized that complications and endocarditiswould be better identified and treated. Medical records of SAB patients admitted in 2011 and 2012 (pre) were analysed. In2013, a protocol, describing risk factors, diagnostic classification and recommended treatment, was implemented. In 2014 and2015 (post), SAB patients were followed prospectively. Transthoracic (TTE) or transoesophageal cardiac ultrasound (TEE) waschosen following a decision tree. A resident internal medicine acted as contact person. Pre-intervention, 98 patients were eligiblefor analysis compared to 85 patients post-intervention. Age and number of risk factors were slightly higher post-intervention;other baseline characteristics were similar. Most SAB-patients were classified as complicated (89 and 82% pre- and postintervention,respectively). Follow-up blood cultures drawn within 2 days after initiating treatment increased from 51 to 85%.Cardiac ultrasounds increased from 44 to 83% for TTE and 13 to 24% for TEE. Endocarditis was more frequently diagnosed (4vs. 12%). Additionally, duration of antibiotic therapy increased. The 3-month mortality did not change significantly (33% preinterventionvs. 35% post-intervention; p > 0.05). Introduction of a hospital-wide protocol for SAB management increasedstandard of care, created awareness among clinicians to properly classify SAB, search for endocarditis and adapt duration ofantibiotic treatment. Mortality did not decrease.Keywords Staphylococcus aureus . Bacteraemia . Treatment . Echocardiography . Infective endocarditi